Implications of Major Learning Theories for Online Medical Education: A Narrative Review

Document Type : Review Article


1 Student Research Committee of Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of E-Learning in Medical Sciences, Virtual School and Center of Excellence in E-Learning, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Online education allows students and instructors to participate regardless of distance or time zone. Online learning systems can be utilized to determine learners’ requirements. Learning approach principles and the student’s learning scheme should be considered for successful instruction. In this study, we aimed to review the literature on major learning approaches for online medical education. 
Methods: Given the fundamental role of learning theory principles in the online learning environment, specifically in medical education, and to improve online instruction, we reviewed and categorized four crucial learning theories and their implications for online medical education. We utilized the ERIC, Scopus, Google Scholar, and ProQuest databases to review the literature from 2000 to 2023 on various aspects of learning theories and their implications in online medical education. 
Results: This review study revealed various implications of online medical education based on the major learning schools which can be utilized in online learning situations based on the instructional design goals and objectives. This study retrieved 59 published articles that considered behaviorism, cognitivism, constructivism, and connectivism as the major learning theories and revealed that all these learning theories are applicable in online learning environments in various aspects, specifically in the medical field. 
Conclusion: The fundamental ideas and structures of various schools of thought share similarities, providing an opportunity to incorporate principles from different approaches into online medical education materials. Learning theories can be utilized for selecting appropriate practice for various learning goals.


Zahra Zolfaghari (Google Scholar)

Zahra Karimian (Google Scholar)


  1. Gilbert B. Online learning revealing the benefits and challenges. 2015.
  2. Andrews R. Does E-Learning Require a New Theory of Learning? Some Initial Thoughts. Journal for Educational Research Online. 2011;3(1):104-23.
  3. Pange A, Pange J. Is E-Learning Based on Learning Theories? A Literature Review. World Academy of Science Engineering and Technology. 2011;5(8):56-60.
  4. Anderson T. The Theory and Practice of Online Learning: AU Press, Athabasca University; 2011. p.484.
  5. Arghode V, Brieger EW, McLean GN. Adult learning theories: implications for online instruction. European Journal of Training and Development. 2017. doi:10.1108/EJTD-02-2017-0014.
  6. Donkin R, Yule H, Fyfe T. Online case-based learning in medical education: a scoping review. BMC Medical Education. 2023;23(1):564.
  7. Delungahawatta T, Dunne S, Hyde S, Halpenny L, McGrath D, O’Regan A, et al. Advances in e-learning in undergraduate clinical medicine: a systematic review. BMC Medical Education. 2022;22(1):711. doi:10.1186/s12909-022-03773-1.
  8. Badyal DK, Singh T. Learning theories: the basics to learn in medical education. International Journal of Applied and Basic Medical Research. 2017;7(Suppl 1):S1.
  9. Torre DM, Daley BJ, Sebastian JL, Elnicki DM. Overview of current learning theories for medical educators. The American journal of medicine. 2006;119(10):903-7.
  10. Chen JC. Teaching nontraditional adult students: Adult learning theories in practice. Teaching in Higher Education. 2014;19(4):406-18. doi:10.1080/13562517.2013.860101.
  11. Braat M, Engelen J, van Gemert T, Verhaegh S. The rise and fall of behaviorism: The narrative and the numbers. History of Psychology. 2020;23(3):252.
  12. Rumbaugh DM. Emergents and rational behaviorism. Journal of Cognitive Education and Psychology. 2002;2(2):163-71.
  13. Reimann A. Behaviorist Learning Theory. The TESOL Encyclopedia of English Language Teaching. 2018;12:1-6. doi: doi:10.1002/9781118784235.eelt0155.
  14. Araiba S. Current diversification of behaviorism. Perspectives on behavior science. 2020;43(1):157-75.
  15. Ally M. Foundations of educational theory for online learning. In The Theory and Practice of Online Learning Athabasca, Alberta. 2008:1-22.
  16. Bacanlı H. Behaviorist approach. U Z Kaya, S Akdemir (ur), Learning and teaching: Theories, approaches and models. 2016:19-30.
  17. Muhajirah M. Basic of Learning Theory: (Behaviorism, Cognitivism, Constructivism, and Humanism). International Journal of Asian Education. 2020;1(1):37-42. doi: 10.46966/ijae.v1i1.23.
  18. Nevin JA. Analyzing Thorndike’s law of effect: The question of stimulus—response bonds. Journal of the experimental analysis of behavior. 1999;72(3):447-50.
  19. Brau B, Fox N, Robinson E. Behaviorism. 2020.
  20. Morris EK, Smith NG, Altus DE. BF Skinner’s contributions to applied behavior analysis. The Behavior Analyst. 2005;28:99-131.
  21. Malone JC. Did John B. Watson really “found” behaviorism? The Behavior Analyst. 2014;37(1):1-12. doi:10.1007/s40614-014-0004-3.
  22. Tadayon R. Bandura’s social learning theory & social cognitive learning theory. Recuperado de www simplypsychology org/bandura html. 2011.
  23. Reimann A. Behaviorist learning theory. The TESOL Encyclopedia of English Language Teaching. 2018:1-6. doi:10.1002/9781118784235.eelt0155.
  24. Utami BNP, editor The Behaviorism Perspectives on English Learning: Its Theorical and Implications for Foreign English Learner in Online Learning Era. Proceeding of International Conference on Islamic Education; 2021.
  25. Malikowski SR, Thompson ME, Theis JG. A model for research into course management systems: Bridging technology and learning theory. Journal of educational computing research. 2007;36(2):149-73.
  26. Zhou M, Brown D. Educational Learning Theories: 2nd Edition: Education Open Textbooks. 1.; 2015.
  27. Hodges BD, Kuper A. Theory and practice in the design and conduct of graduate medical education. Academic Medicine. 2012;87(1):25-33. doi:10.1097/ACM.0b013e318238e069.
  28. Nalliah S, Idris N. Applying the learning theories to medical education: A commentary. educational psychology. 2014;8(1):50-7.
  29. Lilienfeld SO. Psychology: A framework for everyday thinking. (No Title). 2010.
  30. Clark KR. Learning theories: cognitivism. Am Soc Radiol Tech; 2018. p. 176-9.
  31. Al-Jarrah TM, Mansor N, Talafhah RH, Al-Jarrah JM. The application of metacognition, cognitivism, and constructivism in teaching writing skills. European Journal of Foreign Language Teaching. 2019.
  32. Bandura A. Social-cognitive theory. An introduction to theories of personality: Psychology Press; 2014. p. 341-60.
  33. So I. Cognitive development in children: Piaget development and learning. Journal, of Research in Science Teaching. 1964;2:176-86. doi:10.1002/tea.3660020306.
  34. Mcleod S. Vygotsky’s sociocultural theory of cognitive development. Retrieved from Simply Psychology: https://www simplypsychology org/vygotsky html. 2022.
  35. Ozdem-Yilmaz Y, Bilican K. Discovery Learning—Jerome Bruner. Science education in theory and practice: An introductory guide to learning theory. 2020:177-90.
  36. Agra G, Formiga NS, Oliveira PSd, Costa MML, Fernandes MdGM, Nóbrega MMLd. Analysis of the concept of Meaningful Learning in light of the Ausubel’s Theory. Revista brasileira de enfermagem. 2019;72:248-55.
  37. Efgivia MG, Ukhrowati U, Ulfah M, Fitriah M, editors. Implementation of Cognitivism Theory in the Learning Process at Riyadlul Jannah Middle School in the Pandemic Era. 1st UMGESHIC International Seminar on Health, Social Science and Humanities (UMGESHIC-ISHSSH 2020); 2021: Atlantis Press.
  38. Koch I, Poljac E, Müller H, Kiesel A. Cognitive structure, flexibility, and plasticity in human multitasking—An integrative review of dual-task and task-switching research. Psychological bulletin. 2018;144(6):557.
  39. Touya G, Zhang X, Lokhat I. Is deep learning the new agent for map generalization? International Journal of Cartography. 2019;5(2-3):142-57. doi:10.1080/23729333.2019.1613071.
  40. Lachman R, Lachman JL, Butterfield EC. Cognitive psychology and information processing: An introduction: Psychology Press; 2015.
  41. Qiao YQ, Shen J, Liang X, Ding S, Chen FY, Shao L, et al. Using cognitive theory to facilitate medical education. BMC medical education. 2014;14(1):1-7. doi:10.1186/1472-6920-14-79.
  42. Kaufman DM. Teaching and learning in medical education: how theory can inform practice. Understanding medical education: evidence, theory, and practice. 2018:37-69.
  43. Troelstra AS. History of constructivism in the 20th century. Set Theory, Arithmetic, and Foundations of Mathematics. 2011:150-79. doi:10.1017/CBO9780511910616.009.
  44. Wrenn J, Wrenn B. Enhancing learning by integrating theory and practice. International Journal of Teaching and learning in higher education. 2009;21(2):258-65.
  45. Ültanir E. An epistemological glance at the constructivist approach: Constructivist learning in Dewey, Piaget, and Montessori. International journal of instruction. 2012;5(2).
  46. Mattar J. Constructivism and connectivism in education technology: Active, situated, authentic, experiential, and anchored learning. Revista Iberoamericana de Educación a Distancia. 2018;21(2):201-17.
  47. Vygotsky L, Cole M. Lev Vygotsky: Learning and social constructivism. Learning theories for early years practice. 2018;66:58.
  48. Rannikmäe M, Holbrook J, Soobard R. Social Constructivism—Jerome Bruner. Science education in theory and practice: An introductory guide to learning theory. 2020:259-75. doi:10.1007/978-3-030-43620-9_18.
  49. El-Beheiry M, McCreery G, Schlachta CM. A serious game skills competition increases voluntary usage and proficiency of a virtual reality laparoscopic simulator during first-year surgical residents’ simulation curriculum. Surgical endoscopy. 2017;31:1643-50.
  50. Al-Huneidi A, Schreurs J. Constructivism based blended learning in higher education. International Journal of Emerging Technologies in Learning (iJET). 2012;7(1):4-9.
  51. Coman C, Țîru LG, Meseșan-Schmitz L, Stanciu C, Bularca MC. Online teaching and learning in higher education during the coronavirus pandemic: Students’ perspective. Sustainability. 2020;12(24):10367.
  52. Bawa N, Zubairu S. Constructivism and classroom interaction. International Journal of Modern Social Sciences. 2015;4(2):71-81.
  53. Elliott-Kingston C, Doyle OP, Hunter A, editors. Benefits of scenario-based learning in university education. XXIX International Horticultural Congress on Horticulture: Sustaining Lives, Livelihoods and Landscapes (IHC2014): Plenary 1126; 2014.
  54. Hassan SS, Nausheen F, Scali F, Mohsin H, Thomann C. A constructivist approach to teach neuroanatomy lab: students’ perceptions of an active learning environment. Scottish Medical Journal. 2022;67(3):80-6.
  55. Rojanasarot S, Milone A, Balestrieri R, Pittenger AL. Personalized learning in an online drugs and US health care system controversies course. American journal of pharmaceutical education. 2018;82(8):6391.
  56. Jin J, Bridges SM. Educational technologies in problem-based learning in health sciences education: a systematic review. Journal of medical internet research. 2014;16(12):e251.
  57. Goldie JGS. Connectivism: A knowledge learning theory for the digital age? Medical teacher. 2016;38(10):1064-9.
  58. Mehrfar A, Zolfaghari Z, Hejazi Y, Zarifsanaiey N. Ethical Principles in E-Learning; Investigating Key Issues in Instructional Design and Teaching Methods: A Narrative Review. Interdisciplinary Journal of Virtual Learning in Medical Sciences. 2023;14(4):251-62.
  59. Duke B, Harper G, Johnston M. Connectivism as a digital age learning theory. The International HETL Review. 2013;2013(Special Issue):4-13.
  60. Utecht J, Keller D. Becoming Relevant Again: Applying Connectivism Learning Theory to Today’s Classrooms. Critical Questions in Education. 2019;10(2):107-19.
  61. Betts GT, Carey RJ, Kapushion BM. Autonomous learner model resource book: Routledge; 2021.
  62. Raushan A. ICT enabled classroom for creating Autonomous learner: Issues and Challenges. Educational Resurgence Journal. 2020;2(3):58-64.
  63. Baturay MH. An overview of the world of MOOCs. Procedia-Social and Behavioral Sciences. 2015;174:427-33.
  64. Tinmaz H. Social networking websites as an innovative framework for connectivism. Contemporary Educational Technology. 2012;3(3):234-45.
  65. Ozturk HT. Examining value change in MOOCs in the scope of connectivism and open educational resources movement. The International Review of Research in Open and Distributed Learning. 2015;16(5).
  66. Sozudogru O, Altinay M, Dagli G, Altinay Z, Altinay F. Examination of connectivist theory in English language learning: The role of online social networking tool. The International Journal of Information and Learning Technology. 2019;36(4):354-63.
  67. Vas R, Weber C, Gkoumas D. Implementing connectivism by semantic technologies for self-directed learning. International Journal of Manpower. 2018;39(8):1032-46.
  68. Aveiro-Róbalo TR, editor Distance learning and its relation to medical education in the present times. Seminars in Medical Writing and Education; 2022. doi:156294/mw202210.
  69. Lee JX, Ahmad Azman AH, Ng JY, Ismail NAS. Reflection of connectivism in medical education and learning motivation during COVID-19. MedRxiv. 2020:2020.07. 07.20147918.
  70. Suwannaphisit S, Anusitviwat C, Hongnaparak T, Bvonpanttarananon J. Expectations on online orthopedic course using constructivism theory: A cross-sectional study among medical students. Annals of Medicine and Surgery. 2021;67:102493.
  71. Ruiz JG, Mintzer MJ, Leipzig RM. The impact of e-learning in medical education. Academic medicine. 2006;81(3):207-12.
  72. Masters K, Correia R, Nemethy K, Benjamin J, Carver T, MacNeill H. Online learning in health professions education. Part 2: Tools and practical application: AMEE Guide No. 163. Medical Teacher. 2024;46(1):18-33. doi:10.1080/0142152023.2259069.
  73. Yilmaz K. The cognitive perspective on learning: Its theoretical underpinnings and implications for classroom practices. The Clearing House: A Journal of Educational Strategies, Issues and Ideas. 2011;84(5):204-12.
  74. Conway C, Edgar S, Hansen E, Palmer CM. Book review: Learning in adulthood: A comprehensive guide. SAGE Publications Sage CA: Los Angeles, CA; 2012.
  75. Arghode V, Wang J. Exploring trainers’ engaging instructional practices: a collective case study. European Journal of Training and Development. 2016. doi:10.1108/EJTD-04-2015-0033.
  76. Kropf DC. Connectivism: 21st Century’s New Learning Theory. European Journal of Open, Distance and E-Learning. 2013;16(2):13-24.